Why do HIV+ people in New Zealand have to wait to fall ill before they’re allowed medication?

A petition has been launched in New Zealand demanding that PHARMAC, the government agency that decides what drugs will receive public funding, makes HIV medication available to everyone diagnosed with the virus.

PHARMAC will currently only fund anti-retroviral treatment if a HIV+ person has a CD4 count that falls below 500.

This threshold indicates that HIV has already begun to wreak significant damage on that person’s immune system and they are at heightened risk of opportunistic infections.

A CD4 count of less than 200 would constitute an AIDS diagnosis, according to the US Centers for Disease Control and Prevention.

In years past, most countries followed a similar policy. However, there is now overwhelming evidence that treating someone as soon after diagnosis as possible can significantly prolong their life.

On top of this, if they are on treatment and have an undetectable viral load, it vastly reduces the likelihood on them passing on the virus to others. This drives down infection rates.

Because of this, the World Health Organization (WHO) issued a public recommendation in 2015 that everyone diagnosed with HIV should be allowed access to anti-retrovirals as soon as possible.

It concluded such action could help ‘avert more than 21 million deaths and 28 million new infections by 2030.’

It is now common to put people with HIV on to medication quickly after diagnosis in countries such as the US, UK and Australia.

However, sexual health campaigners in New Zealand are frustrated that the country still lags behind.

They used World AIDS Day last week to launch a petition calling for a change in policy.

‘No brainer’

New Zealand has a population of 4.5million. There are approximately 3,200 people living with HIV. Around 80% of infections that occur in the country affect gay and bisexual men.

Jason Myers is the Executive Director of New Zealand AIDS Foundation (NZAF), which launched the petition told GSN in a phone call that putting HIV+ people on to medication was a, ‘no brainer’.

‘All the evidence is now there, as well as the recommendations from the World Health Organization: immediate treatment after diagnosis is the best thing.

‘It’s not only the best thing for the person living with HIV, in terms of optimizing long-term health, but from a prevention perspective, we know that people who are living HIV who are on treatment and have a suppressed viral load, it is virtually impossible for them to pass HIV.

‘The 500 CD4 threshold needs to go.

‘Even from a cost-benefit perspective it’s a no brainer. If we front load the investment into immediate treatment the long-term potential health savings from reducing onward transmission are significant.’

‘We’re unable to provide a timeframe on when, or if, a funding decision might be made’

Approached for comment, PHARMAC sent us the following statement from its acting Chief Executive, Sarah Fitt.

‘PHARMAC fully recognizes the unmet health need for people living with HIV, and we will continue to work towards advancing funded treatment options.

‘PHARMAC has received an application to allow open funded access to HIV treatments by removing the CD4 count criteria.

‘We have sought expert clinical advice on this and our advisers recommended that we fund this, with a medium priority.

‘We continue to keep the removal of the “CD4” threshold for HIV medications under active review, however we’re unable to provide a timeframe on when, or if, a funding decision might be made.’

Until then, those with HIV who are not on treatment will have to wait until the virus begins to damage their health.

Asked how this left those affected by the virus feeling – angry, frustrated or confused – Myers says, ‘all of those things.

‘There is some anger. There’s some confusion too, because all the evidence is there.

‘Once they understand that going on to treatment is the best thing for their health, and is good for prevention, most people are very keen to get on to treatment.

‘People I’ve spoke to with HIV find the notion of obtaining an undetectable viral load incredibly empowering because it’s a real fear of people living with HIV that they may transmit the virus.’

Myers says he’s heard anecdotal stories of people importing HIV medication from abroad, along with PrEP (which is also not funded), although there have been no factual studies to prove this.

Part of the frustration stems from the fact that Myers, and others, had hoped a policy change would have been implemented by this stage.

‘We had a meeting with the Minister of Health, Dr Jonathan Coleman, earlier in the year and he was quite positive, saying “PHARMAC is getting a budget injection and I expect that will go deep enough to get rid of threshold,” but when that budget injection happened, it didn’t go deep enough.’

He says that political support for a policy change has not materialized.

‘We don’t have government lobbying against this, but we also don’t have anyone advocating for it.’

‘2015 was the worst year on record’

Until there is a policy change, campaigners will continue to battle for a major tool in transmission prevention.

According to NZAF, roughly 600 New Zealanders have been diagnosed with HIV since February 2014 and rates are continuing to rise.

‘2015 was the worst year on record,’ they say in a statement. ‘How much more do they need to rise for PHARMAC to make it a top priority?’